Background: Ischemia/reperfusion (I/R) injury is a common complication of hepatic surgery associated with poor prognosis. Ferroptosis of hepatocytes is a critical factor in I/R injury and subsequent liver failure. Propofol injectable emulsion (PIE) is the most commonly used intravenous anesthetic in clinical practice, making it an ideal candidate for potentially regulating ferroptosis and achieving clinical intervention during hepatic I/R injury. However, the current research is still in the preliminary stages. This study aimed to explore whether PIE could alleviate I/R injury by inhibiting ferroptosis in hepatocytes to provide a new strategy for perioperative organ protection. Methods: In this study, we compared the effects of PIE and its two major components (propofol and lipid emulsion) on I/R injury. In vitro, rat hepatocytes (IAR20 cells) were subjected to hypoxia/reoxygenation (H/R) or erastin-induced ferroptosis, followed by treatment with PIE, propofol, or lipid emulsion alone. Cell viability, mitochondrial morphology and membrane potential, reactive oxygen species (ROS) and Fe2+ levels were assessed. A rat hepatic I/R model was established in vivo with treatments administered before ischemia. Histopathology and serum alanine transaminase (ALT), aspartate transaminase (AST) levels, malondialdehyde (MDA) levels, and tissue Fe2+ levels were analyzed. RNA sequencing was used to identify differentially expressed genes (DEGs) and then their expressions were validated after different treatments. Finally, glutathione peroxidase 4 (GPX4) knockdown and overexpression experiments were performed in IAR20 cells to determine whether GPX4 upregulation is essential for the hepatoprotective effects of PIE. Results: PIE and lipid emulsion could restore IAR20 cell viability after H/R injury compared with propofol, and significantly mitigated erastin-induced ferroptosis assessed by changes in mitochondrial morphology, mitochondrial membrane potential, intracellular ROS, and Fe2+ levels. Similarly, PIE and lipid emulsion lowered ALT and AST levels and improved histopathological scores after hepatic I/R injury in rats. Moreover, during H/R or I/R injury, PIE and lipid emulsion protected hepatocytes against ferroptosis, which was consistent with the effects induced by exposure to the ferroptosis inhibitor ferrostatin-1, whereas propofol treatment did not. Then GPX4 expression was significantly downregulated after H/R injury but was restored by PIE and lipid emulsion treatment through RNA sequencing, quantitative real-time polymerase chain reaction (RT-qPCR) and Western blot analyses. Finally, GPX4 knockdown and overexpression experiments in IAR20 cells demonstrated that propofol, PIE, and lipid emulsion ameliorated ferroptosis and cellular injury resulting from GPX4 knockdown, revealing the crucial role of GPX4 in hepatoprotective effect of PIE. Conclusions: PIE protected hepatocytes against I/R injury by inhibiting ferroptosis, potentially through the upregulation of GPX4 expression, with the lipid emulsion identified as the primary mediator of this effect.

Multiple sclerosis (MS) is a chronic neuroinflammatory disorder, and approximately 50% of MS patients develop depression, making it one of the most common comorbidities of the disease. MS-related depression significantly reduces quality of life, worsens neurological disability, and increases suicide risk. Despite its high prevalence, the underlying mechanisms remain unclear. While neuroinflammation and neurotransmitter dysregulation have been implicated, recent evidence suggests that ferroptosis, an iron-dependent form of cell death, may contribute to both neuronal death and mood disturbances in MS patients. Ferroptosis is driven by iron accumulation, lipid peroxidation (LPO), and oxidative stress, all of which are elevated in MS lesions. The inflammatory environment in MS may exacerbate ferroptosis-related processes, potentially contributing to demyelination, neuronal dysfunction, and altered neurotransmitter metabolism-factors strongly linked to depressive symptoms. This review examines the potential role of ferroptosis in MS progression and MS-related depressive symptoms, with a particular focus on oxidative damage and inflammatory signaling related to iron metabolism in the central nervous system (CNS). Understanding these mechanisms may inform future therapeutic hypotheses for MS patients suffering from depression.

INTRODUCTION:To evaluate the association between longitudinal changes in Observed-to-Expected Lung-to-Head Ratio (O/E LHR) measured by ultrasound and postnatal survival in fetuses with Congenital Diaphragmatic Hernia (CDH). METHODS:A total of 74 pregnant women carrying fetuses with CDH were retrospectively analyzed. The change in O/E LHR (ΔO/E LHR) was assessed as a continuous variable using univariate and multivariate logistic regression analyses. Hernia lateralization and liver herniation were combined into a single categorical variable to account for their clinical and statistical correlation. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the discriminative ability of ΔO/E LHR for survival. RESULTS:The majority of patients (86% and 74% according to the first and last ultrasound examinations, respectively) in this cohort had mild CDH, with an overall survival rate of 73.0%. ΔO/E LHR differed significantly between survivors and non-survivors (13.32±22.09 vs. -13.93±17.59, p < 0.001). In multivariate analysis, ΔO/E LHR (OR = 1.089, 95% CI 1.024-1.158; p = 0.007), gestational age at diagnosis (OR = 1.462, 95% CI 1.041-2.053; p = 0.029), and the combined variable of hernia lateralization and liver herniation (p = 0.011) were associated with survival. ROC analysis of ΔO/E LHR yielded an AUC of 0.836 (95% CI 0.725-0.948). CONCLUSION:In this single-center cohort of fetuses with predominantly mild CDH, ΔO/E LHR was associated with postnatal survival and showed good discriminative performance. Gestational age at diagnosis and the combined variable of hernia lateralization and liver herniation were also associated with outcomes. However, estimates for individual anatomical subgroups were imprecise because of the limited number of cases and should not be used for individual risk prediction. These findings suggest that longitudinal assessment of O/E LHR may be more informative than a single measurement in this specific population. Further validation in larger cohorts is warranted.

Cervical cancer is a prevalent gynecological malignancy, and surgical resection can be curative for early-stage disease. Propofol is a commonly used intravenous anesthetic during cervical cancer surgery. However, the effects of propofol on the biological behavior, mRNA transcription, and lipid metabolism of cervical cancer cells remain unclear. In this study, we investigated the impact of clinical-relevant concentrations of propofol on the migration, invasion, transcriptional profiles, and lipid metabolomics of HeLa and C-33 A cells in vitro. HeLa and C-33 A cells were treated with 10 µg/ml propofol or propofol injectable emulsion (PIE). Migration and invasion were assessed using Transwell assays. RNA sequencing (RNA-seq) and liquid chromatography electrospray ionisation tandem mass spectrometry (LC-ESI-MS/MS) were used to analyze mRNA and lipid changes. Western blot was applied to detect enzymes regulating cholesterol metabolism. The key enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) was targeted using siRNA to evaluate cholesterol metabolism. Propofol inhibited the migration of HeLa cells with 0.23-fold compared to control, while PIE restored their migratory capacity. Similarly, propofol reduced the migration of C-33 A cells to 0.22-fold of the control level, whereas PIE restored their migratory ability. RNA-seq, lipid metabolomics and western blot analysis revealed dysregulation of cholesterol metabolism by both propofol and PIE. Specifically, cholesteryl ester and triacylglycerol levels in HeLa and C-33 A cells were altered by propofol treatment, the changes can vary from several folds to hundreds of folds. Propofol modulates cholesterol metabolism in cervical cancer cells, which may impact their migratory potential.

Purpose:Remimazolam is an ultrashort-acting benzodiazepine, which has been indicated to be effective in endoscopic surgery and general anaesthesia. Research on its use in outpatient dental procedures remains limited. This triple-blinded randomized clinical trial was designed to determine whether the quality of postoperative recovery is better with continuous intravenous remimazolam administration compared with midazolam administration for impacted wisdom tooth extraction in patients with dental anxiety. Patients and Methods:This study was a randomized, parallel triple-blinded, superiority trial conducted between 30 April 2022 and 24 June 2024. Participants aged ≥18 years who exhibited dental anxiety and who were eligible for impacted wisdom tooth extraction in an outpatient setting were included in this study. Participants were randomly assigned at a 1:1 ratio to receive either a continuous intravenous infusion of remimazolam or midazolam. The primary outcome was the time to recover full alertness. The secondary outcome was postoperative anterograde amnesia. Results:A total of 150 participants were randomized in this study, with 75 patients assigned to the remimazolam group and 75 patients assigned to the midazolam group. The time to complete alertness was significantly shorter in the remimazolam group than in the midazolam group (3.0 ± 3.6 min vs 4.7 ± 5.2 min, mean difference, -1.9 min; 95% CI, -3.3min to -0.4 min; P = 0.013). The odds of immediate and delayed anterograde amnesia were much reduced with remimazolam administration compared with midazolam administration (immediate: 0.14, 95% CI, 0.05 to 0.34, delayed: 0.07, 95% CI, 0.03 to 0.15, both P < 0.001). Conclusion:For patients with dental anxiety, remimazolam offers not only faster recovery, but also a much better restoration of memory function compared with midazolam. Trial Registration:https://clinicaltrials.gov/study/NCT05350085.

OBJECTIVES:To identify risk factors contributing to prolonged postoperative length of stay (LOS) in very elderly patients following hip fracture surgery, with a focus on postoperative complications and the impact of different anesthesia approaches. METHODS:This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31, 2013 and December 31, 2023. Relevant perioperative data were collected. The primary outcome was postoperative LOS, and the study cohort was divided into two groups: postoperative LOS ≤ 7 days and LOS > 7 days. Logistic regression was performed to identify factors related to prolonged postoperative LOS. RESULTS:A total of 155 patients were included. The average age was 92.7 ± 2.6 years. There were 73 (47%) patients with postoperative LOS > 7 days. Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS (OR = 2.12, 95% CI [1.09, 4.16], P = 0.028). Neither the type of anesthesia (regional vs. general anesthesia, OR = 1.00, 95% CI [0.53, 1.90], P = 0.993) nor the method of airway management (laryngeal mask ventilation vs. spontaneous breathing, OR = 1.46, 95% CI [0.58, 3.76], P = 0.424; endotracheal intubation vs. spontaneous breathing, OR = 0.82, 95% CI [0.39, 1.69], P = 0.592) showed a significant association with a prolonged postoperative LOS. Preoperative chronic obstructive pulmonary disease (OR = 2.78, 95% CI [1.05, 7.65], P = 0.040) and preoperative neutrophil count (OR = 1.13, 95% CI [1.01, 1.26], P = 0.029) were both significantly associated with the occurrence of postoperative pneumonia, while anesthesia type and airway management method were not. CONCLUSIONS:Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery, whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia. Preoperative comorbidities, especially respiratory conditions and systemic inflammation, potentially play a substantial role in postoperative recovery.

Background: The neuropathic pain side induced by Vincristine severely limit its clinical application. However, the mechanism of neuropathic pain is not clear. This study aims to clarify the mechanism of C/EBP-(3 regulating TGF-(31 mediated spinal astrocyte A1/ A2 polarization in the neuropathic pain caused by vincristine. Methods: Neuropathic pain model was established in rats by intraperitoneal injection of Vincristine (VCR). In vitro experiment, the astrocyte model was constructed by Vincristine, and si-C/EBP-(3 was regulated before VCR administration. Pain threshold of rats was measured by thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT), Elisa was used to detect the expression level of inflammatory factors, qRT PCR and Western blotting were used to detect astrocyte polarization markers, C/EBP-(3, TGF-(31, p-smad2 and p-smad3. Results: Following Vincristine administration, the TWL and MWT of rats exhibited a decrease. Additionally, there was an increase in A1 polarization of astrocytes, while A2 polarization remained relatively unchanged. Furthermore, the expression levels of proinflammatory factors were elevated, whereas no significant alterations were observed in anti-inflammatory factors. Notably, Vincristine promoted the expression of C/EBP-(3 and TGF-(31. TGF-(31 inhibitor alleviated VCR induced astrocyte A1 polarization and release of proinflammatory factors, ameliorated abnormal pain. Moreover, silencing C/EBP-(3 reversed the enhanced expression of TGF-(31 induced by Vincristine, attenuated astrocyte A1 polarization and proinflammatory factor release. Conclusion: Vincristine induced spinal cord inflammation by promoting A1 polarization of astrocytes via upregulating the C/EBP-(3/ TGF-(31 signal pathway, thus leading to neuropathic pain. It was different from the traditional signal pathway, this study shown a new signal pathway for astrocyte A1 polarization, which may provide a possibility for clinical treatment of neuropathic pain.

OBJECTIVES:To determine the prevalence, distribution, and associated clinical factors of chronic neuropathic cancer pain (CNCP) among outpatients with chronic cancer pain (CCP) and to inform improved recognition and management. METHODS:In this cross-sectional study, consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain (IASP) criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025. CNCP was diagnosed based on the Neuropathic Pain Special Interest Group (NeuPSIG) criteria. Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria, regardless of coexisting visceral or bone pain. Demographic, oncologic, and pain-related data were collected through standardized interviews. Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests. Logistic regression analyses were conducted to identify clinical factors associated with CNCP. RESULTS:Of 138 eligible patients with CCP, 85 (61.6%) were classified into the CNCP group and 53 (38.4%) into the non-CNCP group. Multivariable logistic regression analysis revealed that bone metastasis (adjusted OR = 2.316, 95% CI: 1.074-5.178, P = 0.032), radiotherapy (adjusted OR = 2.489, 95% CI: 1.119-5.803, P = 0.025), and voiding dysfunction (adjusted OR = 5.470, 95% CI: 2.150-16.396, P < 0.001) were independently associated with CNCP. Pancreatic cancer was inversely associated with CNCP (OR = 0.371, P = 0.031). Only 5 (3.6%) patients in the CNCP group received neuropathic pain-specific interventions, indicating a predominant reliance on single-modality pain management. CONCLUSIONS:CNCP was present in nearly two-thirds of outpatients with CCP. The identified associations with bone metastasis, radiotherapy, and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.

Pregnancy complicated with acute myeloid leukemia is uncommon,requiring the collaborative management by specialists from departments of hematology,obstetrics,anesthesiology,and neonatology for both the parturient and the neonate.This article reports an anesthesic management process of a parturient woman with acute myeloid leukemia and reviews relevant literature published in recent years to systematically summarize the approach for anesthesia-related perinatal management of such patients.

Female hormones, functioning as neuroactive steroids, are utilized beyond menopausal hormone therapy. The rapid onset of allopregnanolone analogs, such as brexanolone and zuranolone, in treating depression, and the effectiveness of megestrol acetate in addressing appetite and weight gain, prompted the Food and Drug Administration to authorize the use of progesterone for treating postpartum depression and cancer-related cachexia. Progesterone has also been found to alleviate neuropathic pain in animal studies. These off-label applications offer a promising option for patients with advanced cancer who often experience various mood disorders such as depression, persistent pain, social isolation, and physical complications like cachexia. These patients have shown low tolerance to opioids and mood-regulating medications. However, the potential risks and uncertainties associated with hormone therapy treatment modalities can be daunting for both patients and medical professionals. This review aims to offer a comprehensive understanding of the non-reproductive functions and mechanisms of female hormones in brain health.

Central post-stroke pain (CPSP), a neuropathic pain syndrome occurring after a cerebrovascular accident, is characterized by pain or paraesthesia in the part of the body dominated by the area of the brain where blood vessels are injured. CPSP patients are often accompanied by anxiety, depression and other emotional disorders, which have a serious negative impact on patients' quality of life. However, the pathogenesis of CPSP has not been fully elucidated, the clinical diagnosis rate is not high, and the commonly used treatment methods are not effective. This article reviews the clinical features, epidemiology, pathogenesis and treatment of CPSP in order to provide reference for the elucidation of CPSP mechanism and effective treatment.

BACKGROUND:Evaluating competency acquisition during residency training is crucial. The Anesthesiology Milestones have been implemented in the United States. The China Consortium of Elite Teaching Hospitals for Residency Education has also developed the Chinese Resident Core Competency Milestone Evaluation System. Despite this, Milestones tailored for anesthesiology have yet to be implemented in China. To address this gap, we have developed Chinese Anesthesiology Milestones. This study aims to assess the reliability and validity of the Chinese Anesthesiology Milestones and their correlation with objective examinations. METHODS:In this single-center cross-sectional study, we included anesthesia residents enrolled in the standardized residency training program at our hospital during the academic year 2021 to 2022. The Chinese Anesthesiology Milestones were developed based on the American version of Anesthesiology Milestones 2.0 and the Chinese Resident Core Competency Milestone Evaluation System using the Delphi method. The Delphi panel comprised a diverse group, including education administrators, faculty from teaching hospitals, and anesthesia residents. Five attending anesthesiologists independently assessed the levels achieved by each anesthesia resident based on the Chinese Anesthesiology Milestones. Subsequently, they collaboratively discussed the ratings for each resident until a consensus was reached. The interrater reliability, internal consistency, and construct validity were assessed using Kendall's coefficient, Cronbach's α coefficient/ composite reliability, and average variance extracted, respectively. Higher values indicated better reliability or validity. The correlation between Milestone ratings and objective examination scores, including written examinations and Objective Structured Clinical Examinations, were analyzed using Pearson correlation. RESULTS:The Chinese Anesthesiology Milestones encompassed 6 competencies, including professionalism, medical knowledge and technical skills, patient care, interpersonal and communication skills, teaching ability, and life-long learning. Milestone evaluation data were available and analyzed from 66 residents. The Kendall's coefficient of concordance among raters ranged from 0.799 (95% confidence interval [CI], 0.793-0.918) to 0.942 (95% CI, 0.934-0.982). The average variance extracted, composite reliability, and Cronbach's α coefficient ranged from 0.782 to 0.920, 0.935 to 0.980, and 0.916 to 0.978, respectively. Correlations between objective examination scores and related Milestone subcompetencies were as follows: written examinations: r = 0.52 (95% CI, 0.22-0.71), technical skills stations: r = 0.51 (95% CI, 0.21-0.71), the oral test station: r = 0.66 (95% CI, 0.45-0.79), and the standardized patient station: r = 0.61 (95% CI, 0.36-0.76). CONCLUSIONS:The Chinese Anesthesiology Milestones demonstrated satisfactory interrater reliability, internal consistency, construct validity, and correlation with objective examination scores within our hospital.

Objective To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery. Methods Patients who underwent elective gynecological surgery at our hospital were consecutively enrolled between October 2020 and January 2022. Core temperature was continuously monitored intraoperatively, and early postoperative complications were collected. By adjusting the logistic regression model for potential confounding factors, the association of postoperative complications with the duration of hypothermia, the lowest body temperature below 36°C, and the hypothermia upon admission to postanesthesia care unit (PACU) or intensive care unit (ICU) were analyzed. Additionally, the potential inflection point in the relationship between the duration of hypothermia and the risk of postoperative complications was explored by using cumulative probability scatter plots and moving average sequences. Results The study included 370 patients, with 193 (52.2%) experiencing hypothermia and 177 (47.8%) not. Among them, 92 (24.9%) developed complications. The duration of hypothermia (adjusted odds ratio [OR] for each one-minute increase: 1.003; 95% confidence interval [CI]: 1.000-1.006, P=0.047) and hypothermia upon admission to PACU or ICU (adjusted OR: 1.980; 95% CI: 1.135-3.454, P=0.016) were associated with early postoperative complications. Notably, the cumulative incidence of postoperative complications tended to rise as the duration of hypothermia increased, with a potential inflection point observed at 120 minutes. Conclusions In gynecological surgery, the duration of hypothermia as well as hypothermia upon admission to PACU or ICU are associated with postoperative complications. Minimizing the duration of hypothermia may be clinically beneficial.

Patients with lymphangioleiomyomatosis (LAM) are considered high risk for most surgeries and require specific anesthetic considerations mainly because of the common spontaneous pneumothorax (PTX). To explore whether intraoperative mechanical ventilation could increase the risk of PTX in those patients, we included 12 surgical patients with LAM in this study, of whom four (33.3%) experienced postoperative PTX. According to our results, patients with higher CT grade, poorer pulmonary function, and a history of preoperative PTX might be more likely to develop postoperative PTX. However, intraoperative mechanical ventilation did not show obvious influence, which might help clinicians reconsider the perioperative management of LAM patients.

OBJECTIVES:To determine the impact of scenario-based lecture and personalized video feedback on anesthesia residents' communication skills during preoperative visits. METHODS:A total of 24 anesthesia residents were randomly divided into a video group and a control group. Residents in both groups took part in a simulated interview and received a scenario-based lecture on how to communicate with patients during preoperative visits. Afterwards, residents in the video group received personalized video feedback recorded during the simulated interview. One week later all the residents undertook another simulated interview. The communication skills of all the residents were assessed using the Consultation and Relational Empathy measure (CARE) scale by two examiners and one standardized patient (SP), both of whom were blinded to the group allocation. RESULTS:CARE scores were comparable between the two groups before training, and significantly improved after training in both groups (all P < 0.05). The video group showed significantly greater increase in CARE score after the training than the control group, especially assessed by the SP (t = 6.980, P <0.001). There were significant correlations between the examiner-assessed scores and SP-assessed scores (both P = 0.001). CONCLUSIONS:Scenario-based lectures with simulated interviews provide a good method for training communication skills of anesthesia residents, and personalized video feedback can enhance their performance on showing empathy during preoperative interview.